Lazarus is an adjunct professor of psychiatry.
“Problems in living” is a broad term that refers to difficulties people may experience in managing or coping with various aspects of activities related to daily living. These problems can be psychological, emotional, social, or practical in nature, and may have a significant impact on a person’s well-being and quality of life. Typical examples include relationship problems, financial hardship, occupational stress, and social isolation.
“Problems in living” can be closely related to social determinants of health. The World Health Organization (WHO) defines social determinants of health as the conditions in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.
For instance, individuals living in poverty (a social determinant) may face numerous “problems in living,” such as lack of access to quality healthcare, lower educational attainment, inadequate housing, and food insecurity, which can all have significant impacts on their physical and mental health.
Similarly, social determinants, like discrimination, social exclusion, and stressful work conditions can also lead to “problems in living,” such as mental health issues, substance use, and chronic health conditions. In this way, the social determinants of health can both contribute to, and exacerbate, a wide range of “problems in living.”
Therefore, addressing problems in living and social determinants of health are important parts of improving overall health outcomes and reducing health disparities in a population.
Here are a few specific examples of the ways the interaction between “problems in living” and social determinants of health can manifest:
Chronic Disease Management: Consider a patient with diabetes who lives in a low-income neighborhood without access to fresh, healthy food (food insecurity). This social determinant of health can exacerbate the patient’s diabetes management, leading to poorer health outcomes.Mental Health: A patient suffering from depression may have their condition worsened by unemployment or job insecurity. The stress of financial instability, a social determinant of health, can intensify feelings of hopelessness and anxiety.Substance Use: An individual living in an area with high rates of drug use and crime may be more likely to struggle with a substance use disorder. The neighborhood, a social determinant, can contribute to the initiation and continuation of substance use.Maternal and Child Health: A pregnant woman without access to prenatal care due to lack of transportation or health insurance may face increased risks for complications during pregnancy and delivery. These social determinants can lead to poorer health outcomes for both the mother and baby. CDC statistics indicate that Black women are three times as likely to die from pregnancy-related causes as white women, and their babies are two to three times more likely to die before their first birthday.Elder Care: An older adult patient with limited mobility living alone may struggle with isolation, which can lead to depression and decline in overall health. Social determinants such as living conditions and social support networks can significantly impact the health of older adults.
In each of these examples, addressing the social determinants of health — such as improving access to healthy food, providing employment support, enhancing community safety, improving access to healthcare, and providing social support for the elderly — can help alleviate the associated “problems in living” and improve health outcomes.
However, clinicians are often specialized in medicine by disease area. While this approach has its merits, it may not be the most effective way to address the complex interplay between health issues and social determinants such as poverty, education, and living conditions.
In light of this, a shift towards a more comprehensive, case-based method, similar to the pedagogical approach used in teaching medical students, may be beneficial. This approach would involve a holistic evaluation of each patient, considering not only their specific medical conditions but also their social circumstances and lifestyle factors.
Utilizing a case-based approach could lead to more personalized care plans tailored to address the individual’s unique set of challenges. This could include linking patients with community resources, providing education on disease management, or making adjustments to treatment plans to account for social determinants of health.
Implementing a case-based approach in the U.S. healthcare system would require several structural changes, such as:
Interdisciplinary Teams: This approach would necessitate the formation of interdisciplinary teams composed of various healthcare professionals such as doctors, nurses, social workers, nutritionists, and mental health professionals. These teams would work collaboratively to address the multiple factors affecting a patient’s health.Training and Education: There would need to be a shift in medical education and training to emphasize the importance of social determinants of health and holistic patient care. This could be incorporated into continuing education programs for practicing physicians.Data Integration: To enable comprehensive patient assessments, healthcare providers need access to a wide range of data. This includes medical history, socio-economic status, education level, and lifestyle factors. Therefore, the healthcare system would need to improve data collection and sharing across different sectors.Policy Changes: Policies and reimbursement models would need to change to incentivize holistic, preventive care rather than focusing solely on treatment. This could involve payment structures that reward healthcare providers for improved patient outcomes rather than the number of services provided, i.e., value-based healthcare.Community Partnerships: Healthcare providers would need to establish partnerships with community organizations that can address social determinants of health. For example, they could work with food banks to help patients access nutritious food, or flag “frequent flyers” in the emergency department for housing agencies to help patients find safe, affordable housing.Patient Engagement: The healthcare system would need to prioritize patient engagement and empowerment. This could involve providing patients with education and resources to manage their health, and involving them in decision-making processes.
The ultimate goal is to improve patient outcomes by addressing the root causes of health problems, rather than merely treating symptoms. Such a radical shift in focus would require significant collaboration across various disciplines and sectors, including healthcare practitioners, social workers, educators, policymakers, and lawmakers. While these changes would require significant effort and resources, they could lead to improved health outcomes, reduced healthcare costs, and a more equitable healthcare system.
A case-based approach to medical practice reflects the teaching methods used in medical school and mirrors the ways students learn. Why not model this behavior in practice as well?
Arthur Lazarus, MD, MBA, is a former Doximity fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine and Medicine on Fire: A Narrative Travelogue.
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